Provider Demographics
NPI:1043909955
Name:SHEPHERD, TAYLOR SHANE (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:SHANE
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 REITER DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1426
Mailing Address - Country:US
Mailing Address - Phone:801-859-2595
Mailing Address - Fax:
Practice Address - Street 1:789 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:OR
Practice Address - Zip Code:97918-1147
Practice Address - Country:US
Practice Address - Phone:801-859-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant